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Abstract

Purpose: 

Fluorine-18 fluorodeoxyglucose positron emission tomography with CT attenuation correction (18F-FDG PET/CT) is useful in the detection and enumeration of focal lesions and in semiquantitative characterization of metabolic activity (glycolytic phenotype) by calculation of glucose uptake. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) have the potential to improve the value of this approach and enhance the prognostic value of disease burden measures. This study aims to determine whether TLG and MTV are associated with progression-free survival (PFS) and overall survival (OS), and whether they improve risk assessments such as International Staging System (ISS) stage and GEP70 risk.Experimental Design: 192 patients underwent whole body PET/CT in the Total Therapy 3A (TT3A) trial and were evaluated using three-dimensional region-of-interest analysis with TLG, MTV, and standard measurement parameters derived for all focal lesions with peak SUV above the background red marrow signal.Results: In multivariate analysis, baseline TLG > 620 g and MTV > 210 cm3 remained a significant factor of poor PFS and OS after adjusting for baseline myeloma variables. Combined with the GEP70 risk score, TLG > 205 g identifies a high-risk-behaving subgroup with poor expected survival. In addition, TLG > 205 g accurately divides ISS stage II patients into two subgroups with similar outcomes to ISS stage I and ISS stage III, respectively.Conclusions: TLG and MTV have significant survival implications at baseline and offer a more precise quantitation of the glycolytic phenotype of active disease. These measures can be assessed more readily than before using FDA-approved software and should be standardized and incorporated into clinical trials moving forward.  

Author information

McDonald JE1, Kessler MM1, Gardner MW2, Buros AF3, Ntambi JA1, Waheed S3, van Rhee F3, Zangari M3, Heuck CJ3, Petty N3, Schinke C3, Thanendrarajan S3, Mitchell A4, Hoering A4, Barlogie B3, Morgan GJ3, Davies FE5.

1 Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

2 College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

3 Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

4 Cancer Research and Biostatistics, Seattle, Washington.

5 Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas. fedavies@uams.edu.